Complex trauma, dissociation, delusion: Presentation of symptoms of an asylum seeker and role of a

psychologist in clarifying it with the legal system

Frozan Esmati, Psychologist

Lynda Crisford, Psychologist

Refugees As Survivors New Zealand

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Background

This case study presents an opportunity to reflect on the psychologist’s input as an expert and experienced witness when attending an asylum seeker’s hearing at Immigration Protection Tribunal.

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Asylum Process

Offering an account

First decision

An appeal process

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(Herlihy, Jobson & Turner, 2012)

Provision of a report

Presence of

Psychologist as a

professional witness

Refugees As Survivors New Zealand - March 2017

Claiming Refugee and Protection Status in New

Zealand, Ministry of Business, Innovation and

Employment, 2015 4

Challenges of Asylum seekers in NZ

• Prolonged Process

• Asylum seeker:

• Separation from family

• Finding employment

• Housing

• Anxiety about the status of their claim

• Presence of symptoms of Post Traumatic Stress Disorder and Complex Grief (In some cases)

• Impact of Trauma on Memory (Herlihy, Jobson & Turner, 2012)

• Immigration:

• Challenges of verification of information

• Credibility and reliability of information (Memon, 2012)

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Case Study

• 30 years old, female, married, middle eastern asylum seeker

• Came to NZ alone as on a three months visitor visa in 2015 to support her sibling following a surgery.

• Her six year child remained with her husband and her in-laws

• Applied for asylum seeker status due to domestic violence towards herself and her son by her in laws

• Self-referred to RASNZ – Mobile team after a suicide attempt.

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Trauma History

• Trauma History:

• Experienced domestic violence as a chid, was subject to domestic violence by in laws after marriage, witnessed her own child getting abused by in laws

• Presentation of Symptoms:

• Symptoms of PTSD

• Sleep disturbances, flashbacks and persistent suicidal thoughts, dissociative reactions

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RASNZ- Mobile team involvement

• RASNZ psychologists (41 sessions, between November 2015-March 2017).

• Psychiatrist (referred by the psychologist): 11 Sessions

• Body Therapy session (referred by the psychologist): 8 Sessions

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Process leading up to being an expert witness

• Client application was declined by Refugee Status Branch (RSB)

• Client appealed to – Immigration Protection Tribunal (IPT)

• For preparation of the client’s documents, her legal representative requested a report that contains:

• Client’s current mental health

• Assessment of trauma related to client’s reported abuse/ongoing abuse to her child in home country

• An assessment of the impact of environmental changes (e.g. deportation) on her psychological and emotional well-being.

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Process leading up to being an expert witness

1. Client’s consent for Psychologist to write a report to lawyer/IPT

2. Management of approval to write the report

3. Delivery of report to the lawyer

4. Extension of hearing by judge

5. Lawyer requested psychologist as expert witness (they were about to lose the case)

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Process leading up to being an expert witness

Challenges involved in making decision to attend:

1. Advocacy and ethical responsibility to clients ( NZ Codes of Ethics for Psychologist working in NZ, 2012).

2. Management approval of the above request

3. Consent of client (education to client on possible implications)

4. Psychologist’s Preparation for the hearing

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Tribunal process

• Clarification of terminology:

• Delusion, dissociation

• Criteria that defines PTSD

• Suicide risk for this client

• History of suicide attempt

• Ongoing domestic violence

• Presence of complex trauma symptoms

• Cross-cultural assessment of client within the context of deportation (Herlihy, Jobson &Turner, 2012)

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Tribunal process

• Provision of insight on credibility of client within the framework of therapy

• Dilemma of advocacy and presentation of unbiased statement to Tribunal.

• The challenge of presenting unbiased evidence after working with client over 31 sessions

• Disclosure of possibly privileged information (Do I know things that tribunal does not and how that impacts the case)?

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Conclusion

• Benefit to legal system:

• Helped the judge in making the decision

• Links to client’s credibility and judges assumptions (bring evidence on credibility) and why more research needs to be done on this area (Herlihy & Turner,2007; Memon, 2012).

• Benefit to the client:

• The case was approved

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Conclusion

• Long term impact on therapeutic relationship:

• The relationship was enhanced

• Client’s expectation raised on clinician’s role in immigration related matters

• Readjustment of boundaries and revision of therapy goals was required.

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Implications

• Long term impact on therapeutic relationship:

• Implications for the client’s symptoms if the case was declined?

• How this impacts on her engaging with the mental health system?

• What happens when person holding the hope (psychologist) loses the case?

• More questions than answers!

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References

• Herlihy, J., Jobson, L. & Turner, S. 2012. Just Tell Us What Happened to You: Autobiographical Memory and Seeking Asylum. Applied Cognitive Psychology. 26:661-676

• Memon, A., 2012. Credibility of Asylum Claims: Consistency and Accuracy of Autobiographical Memory Reports Following Trauma. Applied Cognitive Psychology, 26; 677-679

• Ministry of Business, Innovation & Employment.2015. Claiming Refugee and Protection Status in New Zealand. New Zealand Government.

• Herlihy, J. & Turner, W. S.2007. Asylum Claims and Memory of Trauma. Sharing our Knowledge. British Journal of Psychiatry, 1991,3-4.

• New Zealand Psychologists Board. 2012.Code of Ethics, For psychologists working in Aotearoa/New Zealand. New Zealand Psychologist Board.

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Bibliography

• Herlihy, J., Jobson, L. & Turner, S. 2012. Just Tell Us What Happened to You: Autobiographical Memory and Seeking Asylum. Applied Cognitive Psychology. 26:661-676

• Memon, A., 2012. Credibility of Asylum Claims: Consistency and Accuracy of Autobiographical Memory Reports Following Trauma. Applied Cognitive Psychology, 26; 677-679

• Pourgourides, C. 2006. Dilemmas in the treatment of Asylum seekers. Psychiatry. 6-2

• Bhuyan, R., Vargas, A., Pintin-perez, M. 2016. Fleeing Domestic Violence from a “safe” country? Refugee Determination for Mexican Asylum-Seekers in Canada. Refuge. Volume 32, No. 3.

• Ministry of Business, Innovation & Employment.2015. Claiming Refugee and Protection Status in New Zealand. New Zealand Government.

• Ministry of Health. 2002. Family Violence Intervention Guidelines. Child and Partners Abuse. Retrieved from http://www.health.govt.nz/system/files/documents/publications/family-violence.pdf

• WHO,2011. Preventing Suicide, A global Imperative. WHO

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Thank you

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